胰头癌并门静脉和肠系膜上静脉/脾静脉汇合部同时受侵的血管重建方法  

The method of vascular reconstruction of pancreatic head cancer with portal vein and superior mesenteric vein/spleen vein confluence were both invaded by tumor

作　　者：田雾 顾海涛 孙红成[1] 黄力[1] 陈国庆[1] 钟林[1] TIAN Wu;GU Haitao;SUN Hongcheng;HUANG Li;CHEN Guoqing;ZHONG Lin(Department of Hepatobiliary and Pancreatic Surgery,Shanghai General Hospital,Shanghai 200080,P.R.China;Department of General Surgery,Orthopaedics Hospital of Guizhou Province,Guiyang 550002,P.R.China)

机构地区：[1]上海交通大学附属第一人民医院肝胆胰外科,上海200080 [2]贵州省骨科医院普外科,贵阳550002

出　　处：《中国普外基础与临床杂志》2018年第12期1491-1495,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家重点研发计划子项目(项目编号:2016YFC0104106)

摘　　要：目的总结胰头癌并门静脉(PV)和肠系膜上静脉(SMV)/脾静脉(SV)汇合部同时受侵的胰十二指肠切除术(PD)联合PV和SMV/SV汇合部切除并血管重建这一特殊方法的临床疗效。方法上海交通大学附属第一人民医院于2017年3月收治了1例胰头癌并PV和SMV/SV汇合部同时受侵的患者,根据术前CT检查所示的肿瘤与血管浸润程度判断为Loyer E型。SMV/SV汇合部受侵部分位于SV/SMV汇合部的右侧壁,浸润深度向下未超过SV/SMV汇合部最低点。行PD联合受侵的PV和SMV/SV汇合部右侧部分切除(SMV/SV汇合部右侧部分弧形切除),保留SMV/SV汇合部左侧部分,然后使用人造血管行PV和SMV/SV汇合部残端吻合。结果患者的手术时间共计380 min,出血量约200 mL,PV、SMV及SV的阻断时间分别为35、30及30 min,术后无胰瘘、胆汁漏、切口感染、肺部感染、人造血管感染、血栓、肝功能衰竭等并发症发生。患者于术后第12天痊愈出院。术后1个月复查上腹部CT血管造影(CTA)见人造血管通畅良好;术后3、6、9及12个月电话随访未诉明显不适;术后12个月复查胸腹部CT检查未发现肿瘤复发及转移,复查肝功能正常。结论对胰头癌并PV和SMV/SV汇合部同时受侵者,行PD联合PV和SMV/SV汇合部右侧部分切除,保留SMV/SV汇合部左侧部分,再对PV断端行人造血管重建,这是一种特殊的吻合方法,减少了SV单独重建吻合口,从而缩短了PV阻断时间,缩短肝脏缺血时间,对患者术后肝功能的快速恢复起到了重要的作用。Objective To summary the clinical effect of a special method of vascular reconstruction in pancreaticoduodenectomy (PD)combined with portal vein (PV)and superior mesenteric vein (SMV)/spleen vein(SV) confluence resection in the treatment of pancreatic head cancer with PV.and SMV/SV confluence were both invaded by tumor.Methods Retrospectively summarized the clinical data of i pancreatic head cancer patient who got treatment at Shanghai General Hospital in March 2017,whose PV and SMV/SV confluence wereboth invaded by tumor.According to the preoperative CT judgement,the degree of tumor and vascular infiltration was determined as type of Loyer E,the invasion part was located on the right wall of the SMWSV confluence,and the depth of infiltration did not exceed the lowest point of the SMV/SV confluence junction.This patient underwent PD combined with the invasion of the PV and the right part of SMV/SV confluence resection,with the left part of SMV/SV confluence was retained,and then vascular graft was used for the anastomosis between the PV and the SMV/SV confluence.Results The patient's operative time was 380min,and the blood loss was 200 mL.The blocking time of PV,SMV,and SV was 35,30,and 30min,respectively,without postoperative pancreatic fistula,biliary leakage,incision infection,pulmonary infection,vascular graft infection,blood clots,liver failure,and other complications.The patient recovered and discharged from hospital on postoperative twelfth day.In postoperative 1-month,the patient reviewed on abdomen CT angiography (CTA),showing the vascular graft unobstructed.In postoperative 3-,6-,9-,and 12-month,there was no obvious discomfort,and chest and abdominal CT found no tumor recurrence and metastasis in postoperative 12-months,as well as liver function was normal.Conclusions For pancreatic head cancer with PV and SMV/SV confluence are both invaded by tumor,PD combined with the invasion of the PV and the right part of SMV/SV confluence resection,then the left part of SMV/SV confluence and PV are anastomosed by

关 键 词：胰头癌 胰十二指肠切除术 人造血管重建术 门静脉 肠系膜上静脉 

分 类 号：R735.9[医药卫生—肿瘤]